Insured Beneficiaries with Higher Out-of-Pocket Costs Reduced Screening Colonoscopies During the Recession

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(ChemotherapyAdvisor) – Individuals who had continuous health insurance throughout the recent recession reduced use of screening colonoscopy compared with the two years prior to the recession, a study reported in the March 2012 issue of Clinical Gastroenterology and Hepatology.

Spencer D. Dorn, MD, MPH, of UNC-Chapel Hill School of Medicine, Chapel Hill, NC, and colleagues analyzed administrative data on beneficiaries 50 to 65 years of age from 106 health plans (IMS LifeLink Health Plan Claims Database). The database is nationally representative of the commercially insured U.S. population, and does not include those served by Medicare or Medicaid.

Monthly rates of screening colonoscopies were determined for a period of time that was pre-recession (from January 2005 through November 2007) and through the recession (December 2007 through June 2009).

During the recession, rate of screening colonoscopy significantly decreased by 68.9 colonoscopies per 1 million insured individuals per month compared with pre-recession trends, they found. When these rates were applied to the entire U.S. population, approximately 500,000 fewer screening colonoscopies were performed.

“We found that patients facing high out-of-pocket costs were less likely to undergo colonoscopy at any time point, especially during the recession,” said Dr. Dorn. “Before the recession, these individuals were less likely to get a screening colonoscopy, but the gap in use between those with high and low out-of-pocket costs was narrowing. But when the recession hit full force, the discrepancy in use widened again.” Low out-of-pocket costs were defined as $50 or less; high, $300 or more.

The new healthcare reform act has eliminated Medicare and Medicaid co-payments and deductible requirements for all federally recommended preventive services, including colorectal cancer screening. The authors suggest that commercial insurers “follow suit” by exploring new ways to reduce patient cost-sharing.


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